CTNJ file photo
DSS Commissioner Michael Starkowski and Gov. Rell (CTNJ file photo)

One of the state’s largest health insurance companies informed the Department of Social Services almost two weeks ago that it didn’t plan to bid on Gov. M. Jodi Rell’s Charter Oak health plan for uninsured adults.

“After further review of the RFP and the cost proposal information as well as taking into consideration all of the activity regarding the RFP at the Capitol, neither Anthem nor Anthem Blue Cross and Blue Shield,” will be bidding on the managed care component of the HUSKY health insurance program for low-income families, or the Charter Oak health plan, Anthem President David Fusco wrote in this March 12 letter  to DSS.

“We continue to have concerns about inadequate state funding for full risk HUSKY A and B programs and the new Charter Oak program,” Fusco wrote.

The letter also expressed concerns about Rell’s resolve to enforce the Freedom of Information Act provision, which was included in the RFP. Fusco said the FOIA provision would “place too great a security risk for Anthem’s proprietary information unrelated to the HUSKY program.”

In November Rell terminated the managed care responsibilities of Anthem and Health Net, the two largest HUSKY contractors, for failure to comply with FOIA laws. Anthem will continue to provide some clerical services through June 30, but is not in charge of any managed care responsibilities such as handling medical claims or setting doctors rates. According to the letter, Anthem is willing to continue this clerical relationship with the state, but is not willing to take on the risk as a managed care organization.

State Health Care Advocate Kevin Lembo called today for Rell to rethink.

“Last week 46 advocates urged a more thoughtful and measured restructuring of HUSKY, and now the largest insurer in the HUSKY program has declined to participate in either HUSKY or the Charter Oak Health Insurance Plan as presently designed in the RFP,” Lembo said. “It’ time to move past pride-of-authorship, and rethink the business plan for both HUSKY and Charter Oak.”

Ellen Andrews, executive director of the Connecticut Health Policy Project, said Anthem handles almost half of the HUSKY enrollees, which makes her wonder “how this program can work without Anthem.” She said it looks like Anthem is willing to stay in the program if they don’t have to assume any of the risk. She said Anthem’s letter just reinforces what health care advocates have been saying: “The Charter Oak plan is not sustainable.”

Department of Social Services spokesman David Dearborn doesn’t see it that way. He said Anthem’s departure may “encourage other insurers to bid because now that there’s a potential for a bigger market share.” Dearborn said the department is looking for managed care organizations to run the programs and is not interested in an administrative services contract, which is the risk-free contract Anthem currently has with the state.

“When they submitted their letter of intent, they certainly knew we were returning to a risk-based managed care environment, so the turnaround should cause knowledgeable observers to scratch their heads a bit,” Dearborn said.

Regarding the statements Fusco made about FOIA, Dearborn said, “It is unfortunate that Anthem is bucking the FOIA compliance trend at this point. Several other insurers, however, are indicating they are going to follow through on their letters of intent and submit bids.”

Charter Oak

The Charter Oak health plan is a new program for uninsured adults in the state. Rell has asked bidders to come up with a benefits plan that would keep the premium at $250 per month. Subsidies to cover a portion of the monthly premiums will be offered to some enrollees based on their income. The Department of Social Services estimates that 8,900 to 10,000 people will enroll in the program during the first year, which is scheduled to start July 1.

The Democrat-controlled Human Services Committee has been critical of the Charter Oak plan, and its criticism grew even louder when it published a joint RFP for Charter Oak and HUSKY, which serves more than 330,000 low-income children and their families. More than a week ago, the committee passed legislation to separate the bid process for the two programs, but Rell threatened to veto it because it would delay implementation of the Charter Oak plan.

Democrats say they have more questions than answers. They say they have yet to receive answers about the Charter Oak plan’s financial viability and want to continue the discussion about what benefit levels insurance companies are willing to offer for $250 per month.

Democrats are afraid poor residents with pre-existing medical conditions will discover, after it’s too late, that it fails to cover thousands of dollars in medical costs for prescriptions and durable medical equipment many chronically ill patients need. At the urging of Democratic legislators, the social services department has raised the annual reimbursement rates for both prescriptions and durable medical equipment, but has also asked potential bidders to tell it what benefit levels they would be willing to cover for $250 per month. The benefit levels won’t be clear until the bids are received and reviewed.

The bids are due back at the end of this week. The companies that sent letters of intent to bid include the following: AmeriHealth Mercy Health Plan, Philadelphia, Pa.; Community Health Network of Connecticut, Wallingford; Delta Dental of New Jersey, Parsippany, N.J.; Schaller Anderson Health Plans, LLC, (an Aetna company), Phoenix, Ariz.; and AmeriChoice (a United Health Group company), Vienna, Va.